Nipped in the bid

Healthy-living centres were supposed to encourage health-promoting activities in disadvantaged communities, but so far only 65 of more than 1,000 bids for funding have been approved. What is going wrong, asks Lesley Mountford

Healthy-living centres, part of the government's public health strategy to address ill-health and reduce inequalities, are intended to harness the energy and imagination of local people in promoting health. The projects do not necessarily involve a building, but are expected to be closely linked to local health needs and set up with a high degree of community involvement.

The initiative has a budget of£300m from lottery funds, distributed by the New Opportunities Fund.

The healthy-living centre programme was announced in 1997 as a part of the 'good cause' for health, education and the environment initiative of the National Lottery.

1Competition for funding as a healthy-living centre is fierce. By the deadline of December 2000 1,280 projects had applied to the New Opportunities Fund. It is likely that 300-500 applications will be approved for funding. So far,£45.4m has been distributed across 65 healthyliving centres.

Some people find the two-stage application process difficult and dispiriting. By March this year, 15 applications had been withdrawn, 304 had been rejected at stage one and 657 were still under assessment at the first stage.

Of the 304 which had passed to the second stage, 37 had been rejected and the rest were still in assessment or had been awarded.

I interviewed 11 people who had been involved in bidding for healthy-living centre funding about how they found the process. They included a GP, a National Lottery officer with a city council, and representatives from health-promotion units, a health action zone, voluntary organisations, community development workers and an external consultant.

They felt the process was onerous. One organisation had been successful in securing funding, the others are waiting for a decision.

Where bids involved many partners, the complexity of gathering the information required had created a huge workload. The first stage of the application process involves filling in a 22-page form, which requires applicants to supply detailed information about partnerships involved in the proposed scheme, how it will be managed, and arrangements to ensure all partners can participate on an equal basis. The form also calls for a diagram explaining the proposed management and staff structure of the project, financial projections, proposed timetable for development and anticipated outcomes over the five years of the project.

Although the New Opportunities Fund advised against it, the level of detail required has resulted in external consultants being brought in to draft bids even at stage one. From starting work on the proposal to getting a final decision from the fund can take between two and three years.

Small voluntary organisations whose activities are strongly rooted in deprived communities, providing frontline services, do not generally have the staffing to devote to complicated bid preparation or the resources to bring in external consultants.

For initiatives that involve local communities and small voluntary organisations, it can be difficult to keep people involved and sustain enthusiasm over such long timescales. People move on from the organisations and indeed from the area, making it difficult to keep crucial partnerships alive. To some extent, the lengthy and complicated application process may have excluded the very organisations and communities for whom the money was intended.

The local authority lottery officer said: 'I think the process is stacked against lead organisations who are in the voluntary sector. Stage one is a very thorough assessment and there was a lot of work to be done.

For a voluntary organisation to lead on that for that length of time with the amount of resource required would be difficult.'

A community development manager suggested that organisations where lead members' first language was not English would have found it particularly difficult to participate in the process. But the New Opportunities Fund has pointed out that, in spite of the difficulties, 40 of the projects approved so far are led by voluntary or community-based organisations.

Partnership working is meant to be a key feature of healthy-living centre projects. For many organisations and individuals, closer links with other local agencies have been a major benefit of being involved in the process. Greater understanding between statutory and voluntary sectors has been fostered in many areas. Some of the projects have managed to get new initiatives under way with resources obtained elsewhere.

Others have found that proposals could be realised without additional resources.

But a huge sense of expectation has been built up around these healthy-living centre bids.

Disadvantaged communities, and voluntary and statutory organisations are all eagerly awaiting decisions on their local bids. Inevitably, some worthwhile projects will be denied funding after spending huge amounts of time and energy going through the process. One person involved in bidding said: 'My heart sinks when I think that people have gone through all this and then may not be successful.' The burden of responsibility for the success or failure of a local bid is onerous. One applicant said: 'You have whipped up so much enthusiasm and then you have to come back and say, 'what I wrote wasn't good enough'.'

Healthy-living centres aim to promote good health in its broadest sense. They target deprived areas and those people in the poorest health who find existing health and fitness facilities difficult to access. The centres also reduce differences in the quality of health between individuals. The intention is to encourage innovative ways of working that provide solutions to the challenges presented by different communities and groups.And innovative projects have been funded (see box).

The process has generated enthusiasm and energy for community-based initiatives and a wealth of diverse ideas. But it may also have acted as a barrier to organisations working together and sharing learning, knowing that there have to be losers as well as winners. Arguably, the application process could have been made simpler and more accessible to smaller voluntary organisations with limited resources. For example, the initial bidding stage could have consisted of an expression of interest rather than requiring such detailed information. The large number of applications has been a challenge to the New Opportunities Fund, but to maintain enthusiasm people need feedback and results quickly so that interest does not wane.

Those involved in making applications wanted to be able to access support from others who had already been successful, wanted the New Opportunities Fund to come out to their organisations to assess their project plans and wanted more transparency in the process of assessment. A local strategic overview of who was applying, or an allocation to each area, might have helped bidders to work more closely together.

As for the future, the main concern is how healthyliving centres will be supported when the lottery funding runs out. The national evaluation of healthyliving centres will help determine their future.

Will these innovative projects be taken on by primary care trusts and incorporated into mainstream provision, given other demands on their resources? Or will they be supplanted by the next wheeze from a government pledging further community health initiatives?

REFERENCE 1Department of Health.

Circular MISC (97)83.

Healthy Living Centres, 1997.

Hitting the jackpot: successful healthy-living centre applications Chinese national healthy-living centre Grant:£1.2m Three centres based in London, Birmingham and Sheffield.

Knowle West healthy-living centre Grant:£1.3m Based in Bristol To furnish a healthy-living café and activity rooms in Knowle West Health Park.

On offer will be a range of health services, therapies and counselling.

Health 4 All Grant:£304,944 Based in Preston Will provide affordable keep-fit classes, sports activities for young people, a supply of fresh fruit and vegetables, healthy cooking tips and alternative therapies, such as reflexology.

Newham healthy-living network for elders and carers Grant:£869,038 Based in east London A network of organisations will work together to improve quality of life and health of elders and carers.Services available will include walking and exercise programmes, befriending, relaxation techniques, t'ai chi and programmes to improve access to primary care, dementia services, stroke support and pharmacy.

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